Over 25 million Americans have dental insurance and the number is expected to double within five years. Fiscal intermediaries, both public and private, employ a variety of methods to monitor the quality and cost of dental services. The value of these methods in identifying quality abuses and controlling costs has not been demonstrated. The primary goals of this project are: 1) To determine the most common monitoring method, pretreatment review. Dentists submit treatment plans, and in some cases, radiographs to the third party for review. 2) To explore the effectiveness of a post-treatment assessment based on radiographs submitted for pre-treatment review. To achieve the first goal, 2000 Aetna Insurance employees with dental benefits will be selected. Using treatment plans submitted by community dentists to Aetna for review, project dentists will make two independent assessments of each plan, one based on the usual method of pre-treatment review and the other on the direct examination of patients. Comparisons among the treatment plans of the project dentists, the community dentist and the insurance consultant will allow determination of this review system's potential effectiveness for monitoring the quality and cost of care and its actual effectiveness as presently employed by one carrier. To achieve the second goal, the reliability between quality assessments based on radiographs and the direct examination of 400 patients will be determined. The results of this study should significantly influence the quality assurance system used by PSRO's and other review organizations.